[A new method quantifying tricuspid regurgitant volume by two-dimensional color and continuous wave Doppler...

To determine appropriate surgical management of secondary tricuspid regurgitation (TR), we attempted to quantify TR volume by using two-dimensional color Doppler echocardiography (2-DD) and continuous wave Doppler echocardiography (CW). Thirty patients with TR associated with acquired valvular disease were selected for the study. 1. The new quantitative method: TR was observed from two right-angled cross-sections in 2-DD (one; the parasternal long-axis view of the right ventricular inflow tract, and another; the apical four-chamber view or short-axis view at the level of the aortic valve). The width of the regurgitant jet (a and b) was measured at the position just below the tricuspid valve, and the cross-sectional area (S) of TR was calculated as an ellipse where the major and minor axes were a and b (pi/4.ab). The CW is recorded from the center of the regurgitant jet. The regurgitant volume of one unit area (Vp) was calculated by integrating a parabolic flow velocity signal during ejection phase (2/3.vt, where v = peak velocity, t = regurgitant time). Assuming that the fluid figure of TR flow is oval, the regurgitant volume per one beat (VTR) was calculated by the formula: 1/3.S.Vp = pi/18.abvt. 2. Thirty patients were classified into three groups according to VTR: Group 1, less than 10 cc (n = 12); Group 2, 10-20 cc (n = 12); and Group 3, greater than or equal to 20 cc (n = 6). Compared with pulsed Doppler echocardiography and right ventriculography, our classification was much more practical. Namely, in Group 1, the VTR decreased postoperatively with no surgical intervention for the tricuspid valve; in Group 2, 11 underwent tricuspid annuloplasty (TAP) while one received no surgical intervention, and all showed a decrease (less than 10 cc) in the VTR, in Group 3, five underwent TAP while one patient received tricuspid valve replacement (TVR), and three of the five showed 10-20 cc postoperative VTR. 3. There was a significant correlation between the preoperative VTR and tricuspid annular diameter (TAD) at end-diastole, right atrial mean pressure and right ventricular end-diastolic pressure. In three patients of Group 3 with the residual postoperative VTR of 10-20 cc, preoperative right ventricular systolic pressure and pulmonary capillary pressure were lower; and the preoperative systolic pressure gradient across the tricuspid valve was less than or equal to 20 mmHg and the TAD was greater than 50 mm.(ABSTRACT TRUNCATED AT 400 WORDS)